HomeMy WebLinkAboutMortgage_Buchta STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cntnty Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION 4
Stale Form 43709(813110-15) T
Prescribed by Department of Local Government Finance J__L'
INSTRUCTIONS: e,� File Mark
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To be filed in person or by mail. 9 2016 Form filed with:
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction Is soughht.
Must be filed or postmarked with the CountyAudb3r or County Recorder of the county where the 'mperty is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. I i. i •/ ❑ witty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the reunfyAudito . : ..'% fir
where the property is located during the twelve(12)months before March 31 of each a.a ,, .. .•U i a
yea(��ffi..:x.:.,p •
See reverse side for additional instructions and qualifications.
Annum'(owner or contract buyer-see 'ohs on reversesWe) - /,z ) .
T. b Ali ishi. / Key number l legal description C •�•,-f•(•/v/"'_�1�' Record number Page number
i!: a6 - (B_ 36 - . OO _ 00A . 3c1a-oay go is- sit Y3
Assessed value of red properly as of Mortgage I Contract indebtedness unpaid as of - Mortgage I Contract indebtedness unpaid as of is the appirdm the sole
assessment date,amen year cox:mon:A date,amen year date of application legal or equitable owner?
/D.01000 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than scru m,indicate with whom
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If name on record is afferent than that of applicant,indicate below: Is the property in question:AnnualyAsessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Names of mortgagee or o intact seller `P - _ . it _
mber andslree4 sky an ��'c c,� Via_ �r
Address of mortgagee or contract seller(number and slree4 cry,state.and ZIP code) n
Name of assignee ct other owner or holder of mortgage ' D ra11•er NO °CV 3 .
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Address of assignee(number and street,city,sate,and code) ��j/�
(cJEj�v .2oz. c� /2a-tc /rot A 5 . Card NO. `1
Does applicant own property in any If yes what smarty? . what Taxing District? Has this dedudla
itnd ? ❑Yes ❑No - =rent ? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home egmiy fine ofaedit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR •
Deduction approved in the amount of
20 20 20 20 20 20 20
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Signature of County Auddor County Date(month,day,year)
es‘ I/We certify under the penalty of perjuy that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
( 5'hgpat Z e(owner's fun name) - Date(month,day,year)
./ / skl--a�o. �lnd thoe
Fun address�++of plirant(nwnber and street city,state,and ZIP wile) ^/ /, �7
g7710 S L{,/1 {-(Y icw 'r Dy. , I44 )1.S / r /A `1740. 1 J
Person authorized by duly executed Power ofAttorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street cily,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.